What are the responsibilities and job description for the UM Coordinator position at Imperial Health Plan of California, Inc.?
JOB TITLE: UM Coordinator - Outpatient
DEPARTMENT: Utilization Management
REPORTS TO: Supervisor, Utilization Management
JOB SUMMARY: This position processes authorizations and ensures that all information is correct before submitting for approval. All authorizations should be entered in a timely manner with complete data, as well as all the documents that will support medical necessity. The UM Coordinator will need to have strong written/communication skills in order to provide the Medical Director, providers, and members with the necessary information to ensure the delivery of high-quality, effective healthcare.
Essential Job Functions
DEPARTMENT: Utilization Management
REPORTS TO: Supervisor, Utilization Management
JOB SUMMARY: This position processes authorizations and ensures that all information is correct before submitting for approval. All authorizations should be entered in a timely manner with complete data, as well as all the documents that will support medical necessity. The UM Coordinator will need to have strong written/communication skills in order to provide the Medical Director, providers, and members with the necessary information to ensure the delivery of high-quality, effective healthcare.
Essential Job Functions
- Open and process UM incoming faxes periodically throughout the business day.
- Answer phones: Providing customer service to calls from providers and/or members.
- Print approvals and modification letters from the database on a daily basis.
- Scan any faxes to existing authorizations in the system.
- Route medical reviewers' cases to appropriate personnel in a timely manner on a daily basis.
- Verify duplicate requests and call/notify the doctor's office of referral request cancellations.
- Contact and follow up with providers on pending clinical/documents within the turnaround time. (Routine 5 days, Urgent 72 hours).
- Verify and update all missing information (DOS, POS, outpatient or inpatient) before submitting for approval.
- Adheres to payroll policies and properly uses the timekeeping system with minimal manual changes.
- Maintains regular and consistent attendance.
- Adheres to Compliance Plan and HIPAA regulations
- High school graduate or equivalent.
- 1 year of medical office or healthcare experience required
- Must have experience in making outgoing phone calls as well as taking incoming phone inquiries
Salary : $20 - $22